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What is Chronic Obstructive Pulmonary Disease?
How many people does COPD effect?
What Causes COPD?
What are the Signs and Symptoms of COPD?
How is COPD diagnosed?
How is COPD treated?
How to live with COPD?
For more information
Support Groups

What is Chronic Obstructive Pulmonary Disease?

Chronic obstructive pulmonary disease, or COPD, is an umbrella term for two respiratory illnesses -- chronic bronchitis and/or emphysema. There are 16 million Americans who have been diagnosed with COPD, of whom 14 million have chronic bronchitis and 2 million have emphysema.

COPD results primarily from smoking tobacco. Years of smoking cause damage to the airways in the lungs. This lung damage continues to progress with the use of tobacco. Average current and former smokers will likely not notice or acknowledge symptoms for several years. Typically, they will begin noticing the first symptoms of shortness of breath when they reach their 40s. However, earlier signs of COPD are often present. These include chronic cough and increased mucus production. Recognizing these early signs is important because lifestyle modifications, such as smoking cessation and avoiding respiratory irritants, can be made to prevent additional damage to the airways.

In technical terms, COPD is a slowly progressive disease that is characterized by a decrease in the ability of the lungs to maintain the body's oxygen supply and remove carbon dioxide.[8] As a result of this decrease in lung function, COPD patients alter their lifestyles because they become short of breath after minimal exertion. For example, instead of climbing a flight of stairs COPD patients take the elevator. Physical activities also take longer to complete. Lawn mowing that a COPD patient might have finished in 40 minutes only a year ago may now take an hour to do.

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How many people does COPD effect?

  • An estimated 16 million Americans are diagnosed with COPD.
  • It is likely that an additional 14 million or more COPD cases (those in patients with minimal or no symptoms at all) are undiagnosed. Thus, the true prevalence of COPD may be as high as 30 to 35 million cases.
  • COPD is the fourth leading cause of death in the United States for people ages 65 to 84, and it is the fifth leading cause of death for people ages 45 to 64 and those age 85 and older.
  • More than 100,000 Americans died of COPD in 1997.
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What Causes COPD?

  • Cigarette, Pipe, cigar and other types of tobacco smoking
  • Passive exposure to cigarette smoking
  • Occupational dusts and chemicals
  • Air pollution
  • Genetic factors (less than 5 percent of cases).
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What are the Signs and Symptoms of COPD?

Because COPD is a progressive disease, patients may attribute early symptoms to aging or being out of shape. They may also believe they only have a benign smoker's cough. Although symptoms of COPD may be present earlier, people are typically diagnosed with COPD when they are older than 45 and have at least a 20 pack-year smoking history.[3] Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 (the number of cigarettes in a pack) and multiplying this figure by the number of years a person has smoked. For example, a person who smokes 40 cigarettes a day and has smoked for 10 years would have a 20 pack-year smoking history:
(40 cigarettes per day ÷ 20 cigarettes per pack = 2) ( 2 x 10 years of smoking = 20 pack-year history).

  • breathlessness even after mild exertion
  • chronic coughing, which may or may not produce mucus
  • frequent clearing of the throat
  • chest tightness
  • wheezing
  • Swelling of hands and feet
  • Pink skin
  • Physically thin appearance
  • Barrel-shaped chest
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How is COPD diagnosed?

The diagnostic process for COPD includes a thorough medical history as well as one or more of the following diagnostic procedures.

History and Examination
Patients with COPD usually are current or past smokers over the age of 40 with a history of shortness of breath upon physical exertion and chronic productive cough. The physical examination may show a barrel chest, decreased breath sounds, and wheezing. Signs of right-sided heart failure, such as edema, tender liver, and distended abdomen (caused by fluid accumulation in the abdomen; called ascites) may be noted as well. COPD is a diagnosis of history (in the case of chronic bronchitis), or a diagnosis of anatomy (in the case of emphysema). Clubbing of the fingers rarely occurs in COPD and warrants investigation for other causes.

Pulmonary Function Tests (PFTs)
Pulmonary function tests are the primary diagnostic tools for COPD, after the medical history and physical examination. These tests demonstrate characteristic abnormalities in lung function that, in the proper clinical context (i.e., medical history, physical examination, chest x-ray) confirm or support the diagnosis of COPD and give some idea of the degree of impairment and prognosis. Lung biopsy is rarely used to diagnose emphysema.

There are four components to pulmonary function testing: spirometry , postbronchodilator spirometry , lung volumes , and diffusion capacity . In the initial evaluation, all four components are often performed. Periodically, an individual component, most commonly spirometry, is performed to assess progression of disease and to determine the effectiveness of medication.

  • Spirometry
    The most reliable way to determine reversible airway obstruction is with spirometry, a procedure that measures the amount of air entering and leaving the lungs. This simple test can be performed in most physicians' offices, with the patient sitting comfortably in front of the spirometry machine. The machine measures airflow that passes through the inhalation port attached to the machine. The inhalation device is usually a disposable cardboard tube or a reusable tube that can be sterilized after use.
  • Postbronchodilator Spirometry
    Spirometry is often repeated after giving the patient a bronchodilator, such as an inhaled beta-agonist. If the FEV1 (forced expiratory volume after 1 second) improves more than 12%, the obstruction may be reversible or partially reversible. This procedure provides some information on the potential responsiveness of the airways to medication. It is also useful for determining whether steroid treatment has been beneficial, a few weeks after initiating therapy.
  • Peak expiratory flow rate (PEFR) also can be obtained. PEFR can be compared with readings the patient obtains at home with a peak flow meter. A peak flow meter is a portable device that consists of a small tube with a gauge that measures the maximum force with which one blows air through the tube.
  • Lung Volumes
    Lung volumes are measured in two ways, gas dilution or body plethysmography. The gas dilution method is performed after the patient inhales a gas, such as nitrogen or helium. The amount of volume in which the gas is distributed is used to calculate the volume of air the lungs can hold. Body plethysmography requires the patient to sit in an airtight chamber (usually transparent to prevent claustrophobia) and inhale and exhale into a tube. The pressure changes in the plethysmograph are used to calculate the volumes of air in the lungs.

The most important measurements obtained are residual volume and total lung capacity (TLC). These measurements vary with age, height, weight, and race and are usually expressed as an absolute number and a percentage of what is predicted for a person with normal lung function. A high TLC demonstrates hyperinflation of the lungs, which is consistent with emphysema. Increased residual volume signifies air trapping. This demonstrates an obstruction to exhalation.

  • Diffusion Capacity
    Diffusion capacity is a measurement of gases transferred from the alveoli to the capillary. The patient inhales a very small amount (very safe) of carbon monoxide. How much of it is taken into the blood is measured. A reduced diffusion capacity is consistent with emphysema but is seen in a many other lung diseases as well.

Oximetry
This noninvasive method determines the oxygenation of the blood (O2 sat; normal is greater than 90%) by measuring the amount of light transmitted through an area of skin. The device must be able to read pulsatile flow, so it must pick up a pulse to be accurate. Oximetry is not as accurate as the measurement of arterial blood gases. It is commonly used during exercise and sleep. Exercise oximetry can determine if a patient's oxygen decreases during activity. If so, oxygen therapy with activity may be beneficial. Overnight oximetry is done to see if oxygen concentrations decrease during sleep.

Radiology
Chest x-ray is an imprecise method of diagnosis of COPD. It is only consistently abnormal in severe cases and should be performed in the initial evaluation to exclude other lung diseases. Findings characteristic of COPD in chest x-ray are hyperinflated lungs with flattened diaphragm, hyperlucent lungs (chest film shows greater than normal film blackening from increased transmission of x-rays), and central pulmonary artery enlargement. Bullae, areas of destroyed lung tissue that create large dilated air sacs, may be seen as well.

CT scan may be used to more accurately diagnose emphysema. This is usually not necessary, however, and abnormal lung anatomy is not always detected.

Arterial Blood Gases
Arterial blood gases are measured using blood drawn from an artery, usually in the wrist. Blood is usually drawn from a vein, but venous blood is inaccurate for these measurements. Drawing blood from an artery, unfortunately, causes more discomfort. Arterial blood gases are measured to determine the amount of oxygen dissolved in the blood (pO2), the percentage of hemoglobin saturated with oxygen (O2 sat), the amount of carbon dioxide dissolved in the blood (pCO2), and the amount of acid in the blood pH. The oxygen measure may be used to determine whether a patient needs oxygen therapy. The carbon dioxide measure gives some idea of lung function and is especially important to know when starting oxygen therapy.

Alpha-1-Antitrypsin Level
A person suspected of having a genetic deficiency of this enzyme will undergo this test. Alpha-1-antitrypsin deficiencies can also cause liver disease in children, and the level may be measured for that as well. If the level is low, a genetic probe may be used to determine the cause.

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How is COPD treated?

The COPD patient must stop smoking.

Drugs

Infections can worsen COPD; therefore antibiotics are used during flare-ups of symptoms. Antibiotics are generally used only for acute flare-ups. Patients who experience frequent flare-ups with purulent sputum (a sign of infection) during the year may be placed on a schedule of prophylactic (preventative) treatment with antibiotics the first 10 days of each month. This is done for special cases only.

Surgery

Lung Volume Reduction Surgery
In lung volume reduction surgery (LVRS), the upper portions of the diseased lungs are removed. Although the procedure improves symptoms and lung function for some patients, the reasoning is not understood. It is predicted that the chest wall and breathing muscles return to a place of mechanical advantage. Or it is possible that the elastic recoil of the lungs improves as a result. Currently there is a large multi-center study being performed to determine the benefits of surgery and how to qualify candidates for the procedure. The percentage of patient that currently met the criteria is very low with only 20%-40% of patients qualify.

Lung Transplantation
In some of the most severe cases of COPD a single or double lung transplantation may be an option. The criteria to be selected varies from hospital to hospital.

Medication Nebulizer

Bronchodilators and Anti-inflammatory Agents

Pharmacological treatment involves m edications used to relax the muscle bands that tighten around the airways during an asthma episode (bronchodilators) . Bronchodilators also help clear mucus from the lungs. Some examples of bronchodilators are: beta2 agonists, anticholinergics, and theophylline. In addition to bronchodilators, anti-inflammatory drugs such as corticosteroids can be used. These are most effective when inhaled. There are several delivery methods for inhaled medications , including metered-dose inhalers, breath-actuated inhalers, dry powder inhalers, and nebulizers.

The beta2 agonists relax the smooth muscle thereby decreasing bronchoconstriction and airflow obstruction. They also improve the ability to clear mucus and the endurance of fatigued respiratory muscles. Theophylline is a bronchodilator and an anti-inflammatory agent and is available in pill form or given through an I.V. while hospitalized. Theophylline can cause your airways to relax and open, making it easier to breathe. It can also improve the diaphragm’s ability to contract and increase the clearance of mucus and phlegm. Corticosteroids are often used to treat inflamed airways, but the long-term benefit is not clear. Steroids have not been shown to slow lung decline in COPD. They may reduce the number of flare-ups and improve symptoms in some patients, but there is no convincing evidence to support this. Approximately 10%-15% of COPD patients have a measurable response to corticosteroid therapy. Three mucolytic medications may benefit some patients: guaifenesin, potassium iodide, and N-acetylcysteine. A lot of effort has been put into developing medications (mucolytics) that break up and allow mucus to be cleared more effectively from the airways. Unfortunately, this has met with only very modest success.

Oxygen

Oxygen is the only treatment that has been shown to improve survival. Oxygen is used if your lung function is impaired and your body can no longer absorb enough oxygen from the air. Indications for oxygen therapy include: arterial oxygen pressure is less than 55 mm Hg, or an oxygen saturation of 88% with arterial oxygen pressure of 55-59 mm Hg, or an oxygen saturation of 89% accompanied by cor pulmonale (right-sided heart failure), or polycythemia (proportion of red blood cells above 56% of blood sample).

A patient who does not qualify for oxygen as described may need oxygen while sleeping or exercising. Oxygen may be used at night only if the oxygen pressure at night is less than 55 mm Hg or the oxygen saturation is less than 88%. If the oxygen pressure is less than 55 mm Hg or the oxygen saturation is less than 88% during exercise, oxygen may be prescribed.

Nasal cannula is the most commonly used oxygen delivery system and is usually attached to an oxygen concentrator (not portable) or an E cylinder (portable). There are several oxygen-conserving devices used with these systems.

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How to live with COPD?

Exercise And Eat Well -
Exercise and good nutrition are important parts of maintaining optimal health for everyone, but especially if you have COPD. Keeping your muscles and lungs strong will make it easier to breathe. Maintaining a proper diet helps maintain your energy and wards off potential infections. As with exercise, establishing good eating habits — for example, consuming plenty of fruits and vegetables — will only help your health.

Before starting any type of exercise program, consult your family doctor.

Control Your Coughing And Breathing
Controlled breathing methods and controlled coughing can help you breathe easier.

One method is the Pursed-lip Breathing method

The airways of people with COPD often lose their tone and have a tendency to narrow during exhalation, making efficient lung emptying difficult (the lungs never completely empty). The purpose of this method to prevent the narrowing of the airways using slow, controlled exhalation.

  1. Inhale deeply through your nose if you can. The nose helps to warm, filter and moisten the air you breath.
  2. Exhale slowly through your pursed lips. To purse your lips put them together like you are blowing out a candle or whistling. Remember to blow out slowly and gradually.
  3. Always take about double the amount of time to exhale as it takes you to inhale. For example if it takes you 2 seconds to inhale make sure to exhale for at least 4 seconds.
  4. Practice makes perfect. Although this technique may seem odd at first after doing in several times a day everyday it will become natural to you.
  5. This method is helpful during stressful times of the day and times when you may find it most difficult to breath.
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For more information

American Lung Association
1740 Broadway
New York, NY 10019
Phone: (212) 315-8700
Toll-Free: (800) 586-4872
http://www.lungusa.org/

National Heart, Lung and Blood Institute (NHLBI)
6701 Rockledge Dr.
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
http://www.nhlbi.nih.gov/

National Lung Health Education Program
9425 MacArthur Boulevard
Irving, Texas 75063
Phone: (972) 910-8555
www.nlhep.org

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Support Groups

The Family of COPD Support Programs
The List was established to provide support and education and to be a forum for sharing ideas and solutions in dealing with this affliction. Subscribers are encouraged to participate in the discussion, though they are entitled to just "lurk" if they so choose. The List, and thus this web page, was established to bring together people affected by COPD. It is here to help us communicate with one another, to share ideas and knowledge, to support one another, and to live longer, better quality lives.
COPD-Support, Inc.
P.O. Box 490714
Ft. Lauderdale, FL 33349

COPD Online Support Mailing List Home Page   
The web home of the COPD Online Support Mailing List developed and managed by patients with COPD in cooperation with other COPD patients, caregivers and medical professionals who care.

Chronic Lung Disease Forum
CLD Patients, as well as their families and friends are invited to share their questions, experiences, discoveries and support.

COPD Online Support Mailing List - Caregivers
The web home of the COPD Onl9ine Support Mailing List developed and managed by patients with COPD in cooperation with other COPD patients, caregivrs and medical professionals who care.

COPD Support Group/Forum
Any person who has a lung disease of any kind who would like to talk to someone else in the same situation.

COPD/Emphysema Online Support Mailing List
The mailing list was established to provide support and education, and as a forum for the sharing of ideas and solutions in dealing with this affliction.

Emphysema / Bronchitis Medical Information
A professionally moderated, consumer focused free virtual medical clinic offering detailed medical and drug information and support groups on Emphesyma, Bronchitis and other long term medical conditions.

Emphysema/Bronchitis Support Group
Message board moderated daily by a professional.

DontSmoke.com
Together let's make quitting a PRIORITY and a REALITY! Your FAMILY and your ANIMALS will LOVE you for being a QUITTER! Be sure to visit our website as often as needed to become and stay smokefree!! Please JOIN our mailing list, see our bulletin boards, or come to be adopted!

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